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Mancin S, Sguanci M, Andreoli D, Piredda M, De Marinis MG. Nutritional assessment in acute stroke patients: A systematic review of guidelines and systematic reviews. Int J Nurs Stud 2024; 158:104859. [PMID: 39043111 DOI: 10.1016/j.ijnurstu.2024.104859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/17/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Dysphagia and malnutrition are major contributors to mortality in patients with acute stroke. An early assessment of nutritional status upon hospital admission is crucial to enhance clinical outcomes by reducing the associated high-risk complications. However, the fragmented nature of the existing literature makes it difficult to optimize clinical practices. OBJECTIVE This study aims to identify the best clinical practices that nurses and other healthcare professionals can employ for the immediate assessment of nutritional risk in patients diagnosed with acute stroke. DESIGN Systematic review of clinical practice guidelines and systematic reviews. DATA SOURCES Comprehensive bibliographic searches were conducted up to May 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across the databases Cochrane Library, PubMed, Embase, CINAHL, and Scopus, and three recognized guideline repositories. REVIEW METHODS The quality of clinical practice guidelines was ascertained using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, and the quality of systematic reviews was assessed through A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). The evidence quality was appraised based on the classifications by the European Society of Cardiology. RESULTS Out of 2534 identified records, 15 were incorporated into this review. Predominantly, the selected clinical practice guidelines and systematic reviews exhibited high methodological quality. Notably, the Gugging Swallowing Screen and the Malnutrition Universal Screening Tool were pinpointed as primary tools for initial screenings. Most studies recommended that these assessments, ideally conducted within the first 24 h of patient admission, should be carried out by specially trained professionals, highlighting the pivotal role of nurses. Deviations in screening outcomes necessitate complementary specialist evaluations. CONCLUSIONS This systematic review offers a consolidation of current insights, proposing an innovative and integrated approach to assess nutritional needs of high-risk patients. It underscores the importance of nurses in the screening process, emphasizing their pivotal role in the nutritional management of patients with acute stroke, and advocates for further research endeavors to standardize intervention protocols to elevate patient clinical outcomes. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42023425140.
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Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Desirèe Andreoli
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Roma, Italy.
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Horn J, Simpson KN, Simpson AN, Bonilha LF, Bonilha HS. The Relationship Between Poststroke Dysphagia and Poststroke Depression and Its Risk Factors. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2487-2499. [PMID: 39088240 PMCID: PMC11427738 DOI: 10.1044/2024_ajslp-23-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/03/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE A diagnosis of dysphagia and/or depression after stroke can impact the physical, psychological, and social welfare of stroke survivors. Although poststroke depression (PSD) and poststroke dysphagia are known to occur concurrently, there is a paucity of research that has specifically investigated their association. Therefore, we aimed to study the relationship between PSD and poststroke dysphagia during acute inpatient hospitalization and within 90 days after discharge. Furthermore, we aimed to evaluate the odds and hazard of being diagnosed with depression after stroke and estimate the time to depression diagnosis from the initial stroke diagnosis in patients with and without a diagnosis of dysphagia. METHOD Using the acute inpatient hospital data set from our previous work, we pulled additional postdischarge administrative claims data from the 2017 Medicare 5% Limited Data Set and conducted a retrospective, cross-sectional study of patients diagnosed with poststroke dysphagia and PSD. RESULTS Patients diagnosed with poststroke dysphagia had 2.7 higher odds of being diagnosed with PSD and had an approximately 1.75-fold higher hazard for PSD diagnosis in the 90 days after discharge compared to patients not diagnosed with dysphagia. Risk factors for PSD included having dysphagia, being female, and having dual eligibility. CONCLUSIONS Our results demonstrated a significant association between PSD and poststroke dysphagia. Additional research should further explore the impact of PSD on poststroke dysphagia.
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Affiliation(s)
- Janet Horn
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| | - Kit N. Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston
| | - Annie N. Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston
| | - Leonardo F. Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston
- Department of Neurology, School of Medicine, University of South Carolina, Columbia
| | - Heather S. Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
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Song W, Wu M, Wang H, Pang R, Zhu L. Prevalence, risk factors, and outcomes of dysphagia after stroke: a systematic review and meta-analysis. Front Neurol 2024; 15:1403610. [PMID: 39087010 PMCID: PMC11288910 DOI: 10.3389/fneur.2024.1403610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Background Dysphagia is a common complication after stroke, which not only brings adverse outcomes but also greatly affects the quality of life of patients. At present, there is no systematic review or meta-analysis to comprehensively evaluate the epidemiological characteristics of post-stroke dysphagia (PSD). A systematic review of the prevalence, risk factors, and prognosis of PSD is essential. Methods Through 31 December 2022, a comprehensive literature search was performed for observational studies related to PSD. Five databases were retrieved. Random-effects models were used to estimate the pooled prevalence, odds ratio (OR), and 95% CIs. Results A total of 34 studies were included, and the results showed that the overall prevalence of PSD was 46.6% (95% CI, 0.405-0.528). The prevalence of dysphagia in ischemic stroke and hemorrhagic stroke was 43.6% (95% CI 0.370-0.501) and 58.8% (95% CI 0.519-0.654), respectively. The prevalence of PSD in Africa was 49.4% (95% CI, 0.196-0.792), in Asia was 40.1% (95% CI, 0.348-0.454), in Europe was 45.8% (95% CI, 0.327-0.590), in North America was 44.3% (95% CI, 0.370-0.517), in South America was 57.5% (95% CI, 0.441-0.708), and in Oceania was 64.1% (95%CI, 0.558, 0.724). In risk factor analysis, hypertension, previous stroke, and atrial fibrillation were significantly associated with the occurrence of PSD, pooled OR = 1.179 [(95% CI, 1.002-1.386), p < 0.05], pooled OR = 1.514 [(95% CI, 1.204-1.905), p < 0.001], and pooled OR = 1.980 [(95% CI, 1.580-2.481), p < 0.001]. In outcome studies, the prevalence of aphasia and dysarthria in PSD was 35.6% (95% CI, 0.213-0.499) and 54.5% (95% CI, 0.293-0.798), respectively. The prevalence of respiratory tract infection was 27.1% (95%CI, -0.038-0.579), and the prevalence of pneumonitis was 32.1% (95% CI, 0.224-0.418). Persistence of dysphagia at discharge and at 1 month was 74.5% (95% CI, 0.621-0.869) and 50.9% (95% CI, 0.142-0.876), respectively. Mortality rates for PSD patients during admission and discharge at 1 month, 3 months, and 1 year were 11.8% (95% CI, 0.083-0.152), 26.5% (95% CI, 0.170-0.359), 25.7% (95% CI, 0.19-0.324), and 31.3% (95% CI, 0.256-0.369), respectively. Conclusion This study found that the overall prevalence of PSD was 46.6%. Prevalence is most influenced by the diagnosis method. Hypertension, history of stroke, atrial fibrillation, patient age, and stroke severity were risk factors significantly associated with PSD. The prevalence of aphasia, dysarthria, respiratory tract infection, and pneumonitis in PSD patients is 2-4 times that of patients without PSD.Systematic review registration: www.crd.york.ac.uk/PROSPERO, PROSPERO, CRD42021252967.
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Affiliation(s)
- Wenjing Song
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Minmin Wu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Haoran Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ruifeng Pang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Luwen Zhu
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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Gu H, Ren D. Prevalence and Risk Factors of Poststroke Dysphagia: A Meta-Analysis. Cerebrovasc Dis 2024:1-24. [PMID: 38643757 DOI: 10.1159/000538218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/29/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION In patients with stroke, poststroke dysphagia (PSD) is a common complication that plays an important role in morbidity and mortality. The aim of this paper was to assess the prevalence and risk factors of PSD using a systemic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for potentially eligible studies published until September 2023. Further, the pooled incidence and risk factors for PSD were determined using a random-effects model. Overall, 58 studies involving 37,404 patients with acute stroke were selected for the meta-analysis. RESULTS The pooled incidence of PSD in patients with acute stroke was 42% (95% confidence interval [CI]: 36-48%), which is the highest in South America (47%) and lowest in Asia (37%). Notably, older age (odds ratio [OR]: 2.13; 95% CI: 1.53-2.97; p < 0.001), hypertension (OR: 1.23; 95% CI: 1.06-1.44; p = 0.007), diabetes mellitus (OR: 1.22; 95% CI: 1.04-1.44; p = 0.014), stroke history (OR: 1.26; 95% CI: 1.04-1.53; p = 0.019), and atrial fibrillation (OR: 1.58; 95% CI: 1.02-2.44; p = 0.039) were found to be associated with an increased risk of PSD. Conversely, sex differences, smoking, alcoholism, obesity, hyperlipidemia, ischemic heart disease, stroke type, and the hemisphere affected were not associated with the risk of PSD. CONCLUSION The abstract reports the prevalence of PSD in patients with acute stroke and identified potential risk factors for PSD, including older age, hypertension, diabetes mellitus, stroke history, and atrial fibrillation.
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Affiliation(s)
- Haiyan Gu
- Intensive Care Rehabilitation Department, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Dan Ren
- Intensive Care Rehabilitation Department, Ningbo Rehabilitation Hospital, Ningbo, China
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Krekeler BN, Schieve HJP, Khoury J, Ding L, Haverbusch M, Alwell K, Adeoye O, Ferioloi S, Mackey J, Woo D, Flaherty M, La Rosa FDLR, Demel S, Star M, Coleman E, Walsh K, Slavin S, Jasne A, Mistry E, Kleindorfer D, Kissela B. Health Factors Associated With Development and Severity of Poststroke Dysphagia: An Epidemiological Investigation. J Am Heart Assoc 2024; 13:e033922. [PMID: 38533959 PMCID: PMC11179757 DOI: 10.1161/jaha.123.033922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Dysphagia after stroke is common and can impact morbidity and death. The purpose of this population-based study was to determine specific epidemiological and health risk factors that impact development of dysphagia after acute stroke. METHODS AND RESULTS Ischemic and hemorrhagic stroke cases from 2010 and 2015 were identified via chart review from the GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study), a representative sample of ≈1.3 million adults from southwestern Ohio and northern Kentucky. Dysphagia status was determined on the basis of clinical assessments and necessity for alternative access to nutrition via nasogastric or percutaneous endoscopic gastrostomy tube placement. Comparisons between patients with and without dysphagia were made to determine differences in baseline characteristics and premorbid conditions. Multivariable logistic regression determined factors associated with increased risk of dysphagia. Dysphagia status was ascertained from 4139 cases (1709 with dysphagia). Logistic regression showed that increased age, Black race, higher National Institutes of Health Stroke Scale score at admission, having a hemorrhagic stroke (versus infarct), and right hemispheric stroke increased the risk of developing dysphagia after stroke. Factors associated with reduced risk included history of high cholesterol, lower prestroke modified Rankin Scale score, and white matter disease. CONCLUSIONS This study replicated previous findings of variables associated with dysphagia (older age, worse stroke, right-sided hemorrhagic lesions), whereas other variables identified were without clear biological rationale (eg, Black race, history of high cholesterol, and presence of white matter disease) and should be investigated in future studies to determine biological relevance and potential influence in stroke recovery.
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Affiliation(s)
- Brittany N. Krekeler
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | | | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Mary Haverbusch
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Kathleen Alwell
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Opeolu Adeoye
- Department of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Simona Ferioloi
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Jason Mackey
- Department of NeurologyIndiana University School of MedicineIndianapolisINUSA
| | - Daniel Woo
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Matthew Flaherty
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Felipe De Los Rios La Rosa
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Baptist Health South FloridaMiami Neuroscience InstituteMiamiFLUSA
| | - Stacie Demel
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | | | - Elisheva Coleman
- Department of NeurologyUniversity of Chicago MedicineChicagoILUSA
| | - Kyle Walsh
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Sabreena Slavin
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Adam Jasne
- Department of NeurologyYale School of MedicineNew HavenCTUSA
| | - Eva Mistry
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Dawn Kleindorfer
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Department of NeurologyUniversity of MichiganAnn ArborMIUSA
| | - Brett Kissela
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
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Li J, Huang H, Yan Y, Fu Y, Li M, Ju W, Cai Y, Liu Q, Chen H. Efficacy observation, complications and nursing of enteral nutrition suspension in patients with acute ischemic stroke. Int J Neurosci 2024:1-8. [PMID: 38512133 DOI: 10.1080/00207454.2024.2334368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study focuses on exploring the efficacy observation, complications and nursing aspects of using enteral nutrition suspension in patients with acute ischemic stroke. METHODS This study retrospectively analyzed clinical data from 188 patients with acute ischemic stroke treated in the Neurology Department of our hospital from October 2022 to September 2023. Patients who received intermittent enteral nutrition and nursing interventions were included in the control group (n=96), while patients who received continuous enteral nutrition and nursing interventions were included in the treatment group (n=92). Relevant indicators data changes before and after treatment were recorded for each patient, along with the occurrence of complications in both groups, and statistical analysis was conducted. RESULTS The treatment group had fewer days in the ICU and total hospitalization days compared to the control group, with p < .05. Patients in the treatment group had higher levels of serum albumin and serum prealbumin than those in the control group, with p < .05. The occurrence of abdominal pain, diarrhea, constipation, bloating and acid reflux in the treatment group was lower than in the control group, with p < .05. There was no significant difference in the occurrence of adverse outcomes at discharge, death at discharge, cerebral hemorrhage, lung infection and gastrointestinal bleeding between the two groups (p > .05). CONCLUSION The application of enteral nutrition suspension in patients with acute ischemic stroke effectively provides the necessary nutrients, maintains nutritional balance, promotes tissue repair and recovery and reduces the length of hospital stay.
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Affiliation(s)
- Jie Li
- Intensive Care Unit, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Huiying Huang
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Ying Yan
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Yanli Fu
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Manfang Li
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Wenhui Ju
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Yang Cai
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Qian Liu
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Hongbo Chen
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
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Mao L, Wang J, Li Y, Zheng J, Fan D, Wei S, Wu X, Yang X, Wang D. Risk factors for dysphagia in patients with acute and chronic ischemic stroke: A retrospective cohort study. Heliyon 2024; 10:e24582. [PMID: 38304775 PMCID: PMC10830548 DOI: 10.1016/j.heliyon.2024.e24582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
Background Dysphagia is a common and clinically significant complication of ischemic stroke. The prevalence and risk factors for dysphagia may vary at different stages following an ischemic stroke. Methods This study included patients with acute and chronic ischemic stroke who were treated at the Department of Rehabilitation, First Affiliated Hospital, Zhejiang University School of Medicine from 2019 to 2022. Various demographic, clinical, and laboratory parameters were collected, and statistical analyses were performed to investigate their association with dysphagia. Results Among the 399 ischemic stroke patients included in the study, 165 (41.4 %) experienced dysphagia, with 72 (38.7 %) in the acute phase and 93 (43.7 %) in the chronic phase. Univariate analysis revealed significant associations (p < 0.05) between dysphagia and factors such as pulmonary infection, aphasia, NIHSS score, ADL score, NLR score, lower extremity Brunnstrom's stages, and sit-to-stand balance. Multiple logistic regression analysis, after adjusting for confounding factors, identified the ADL score as an independent predictor of dysphagia. These findings were consistent across three time-windows: the acute phase, the chronic phase, and 180 days after stroke onset. Additionally, the lymphocyte count and pulmonary infection were identified as potential independent indicators. Conclusions This study investigated the prevalence and risk factors for dysphagia in ischemic stroke patients at different time-windows. A low ADL score (<40) may serve as a valuable and reliable predictor for poststroke dysphagia in clinical settings.
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Affiliation(s)
- Lin Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juehan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yubo Li
- Information and Electronic Engineering College, Zhejiang University School, Hangzhou, China
| | - JinJin Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Denghuang Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohong Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Yang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Daming Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Mancin S, Sguanci M, Reggiani F, Morenghi E, Piredda M, De Marinis MG. Dysphagia screening post-stroke: systematic review. BMJ Support Palliat Care 2024; 13:e641-e650. [PMID: 37364991 DOI: 10.1136/spcare-2022-004144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND/SCOPE Stroke is one of the main causes of death, especially when associated with dysphagia. Hence, the assessment of nutritional status and aspiration risk is important to improve clinical outcomes. The aim of this systematic review is to identify which are the most suitable dysphagia screening tools in chronic post-stroke patients. METHODOLOGY A systematic literature search was conducted for articles published from 1 January 2000 to 30 November 2022 in the Cochrane Library, PubMed, Embase, CINAHL, Scopus and Web of Science databases, including primary studies providing quantitative or qualitative data. Additionally, a manual search was conducted scanning the reference lists of relevant articles and Google Scholar was searched to retrieve additional records. The process of screening, selection and inclusion of the articles, as well as the assessment of risk of bias and methodological quality, were conducted by two reviewers. RESULTS Out of the 3672 records identified, we included 10 studies, mostly (n=9) cross-sectional, evaluating screening for dysphagia in 1653 chronic post-stroke patients. Volume-Viscosity Swallow Test was the only test applied in multiple studies with adequate sample size, demonstrating high diagnostic accuracy (sensitivity=96.6%-88.2%; specificity=83.3%-71.4%) compared with the videofluoroscopic swallowing study. CONCLUSIONS Dysphagia is an important complication in chronic post-stroke patients. Early identification of this condition through screening tools with adequate diagnostic accuracy is of paramount importance. The limited number of studies available and their small sample sizes may be a limitation to this study. PROSPERO REGISTRATION NUMBER CRD42022372303.
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Affiliation(s)
- Stefano Mancin
- Nutrition Unit, Cancer Center, IRCCS Humanitas Research Hospital, via Manzoni, 56 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Montpellier, 1- 00128 Rome, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Yoon KJ, Park CH, Rho MH, Kim M. Disconnection-Based Prediction of Poststroke Dysphagia. AJNR Am J Neuroradiol 2023; 45:57-65. [PMID: 38164540 PMCID: PMC10756566 DOI: 10.3174/ajnr.a8074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE Dysphagia is a common deficit after a stroke and is associated with serious complications. It is not yet fully clear which brain regions are directly related to swallowing. Previous lesion symptom mapping studies may have overlooked structural disconnections that could be responsible for poststroke dysphagia. Here, we aimed to predict and explain the relationship between poststroke dysphagia and the topologic distribution of structural disconnection via a multivariate predictive framework. MATERIALS AND METHODS We enrolled first-ever ischemic stroke patients classified as full per-oral nutrition (71 patients) and nonoral nutrition necessary (43 patients). After propensity score matching, 43 patients for each group were enrolled (full per-oral nutrition group with 17 women, 68 ± 15 years; nonoral nutrition necessary group with 13 women, 75 ± 11 years). The structural disconnectome was estimated by using the lesion segmented from acute phase diffusion-weighted images. The prediction of poststroke dysphagia by using the structural disconnectome and demographics was performed in a leave-one-out manner. RESULTS Using both direct and indirect disconnection matrices of the motor network, the disconnectome-based prediction model could predict poststroke dysphagia above the level of chance (accuracy = 68.6%, permutation P = .001). When combined with demographic data, the classification accuracy reached 72.1%. The edges connecting the right insula and left motor strip were the most informative in prediction. CONCLUSIONS Poststroke dysphagia could be predicted by using the structural disconnectome derived from acute phase diffusion-weighted images. Specifically, the direct and indirect disconnection within the motor network was the most informative in predicting poststroke dysphagia.
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Affiliation(s)
- Kyung Jae Yoon
- From the Department of Physical and Rehabilitation Medicine (K.J.Y., C.-H.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
- Medical Research Institute (K.J.Y., C.-H.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Chul-Hyun Park
- From the Department of Physical and Rehabilitation Medicine (K.J.Y., C.-H.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
- Medical Research Institute (K.J.Y., C.-H.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Myung-Ho Rho
- Department of Radiology (M.-H.R., M.K.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minchul Kim
- Department of Radiology (M.-H.R., M.K.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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He Y, Tan X, Kang H, Wang H, Xie Y, Zheng D, Li C. Research trends and hotspots of post-stroke dysphagia rehabilitation: a bibliometric study and visualization analysis. Front Neurol 2023; 14:1279452. [PMID: 38156085 PMCID: PMC10754621 DOI: 10.3389/fneur.2023.1279452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023] Open
Abstract
Background Post-stroke dysphagia (PSD) is one of the most prevalent stroke sequelae, affecting stroke patients' prognosis, rehabilitation results, and quality of life while posing a significant cost burden. Although studies have been undertaken to characterize the pathophysiology, epidemiology, and risk factors of post-stroke dysphagia, there is still a paucity of research trends and hotspots on this subject. The purpose of this study was to create a visual knowledge map based on bibliometric analysis that identifies research hotspots and predicts future research trends. Methods We searched the Web of Science Core Collection for material on PSD rehabilitation research from its inception until July 27, 2023. We used CiteSpace, VOSviewer, and Bibliometrix R software packages to evaluate the annual number of publications, nations, institutions, journals, authors, references, and keywords to describe present research hotspots and prospective research orientations. Results This analysis comprised 1,097 articles from 3,706 institutions, 374 journals, and 239 countries or regions. The United States had the most publications (215 articles), and it is the most influential country on the subject. "Dysphagia" was the most published journal (100 articles) and the most referenced journal (4,606 citations). Highly cited references focused on the pathophysiology and neuroplasticity mechanisms of PSD, therapeutic modalities, rehabilitation tactics, and complications prevention. There was a strong correlation between the terms "validity" and "noninvasive," which were the strongest terms in PSD rehabilitation research. The most significant words in PSD rehabilitation research were "validity" and "noninvasive brain stimulation," which are considered two of the most relevant hotspots in the field. Conclusion We reviewed the research in the field of PSD rehabilitation using bibliometrics to identify research hotspots and cutting-edge trends in the field, primarily including the pathogenesis and neurological plasticity mechanisms of PSD, complications, swallowing screening and assessment methods, and swallowing rehabilitation modalities, and this paper can provide in the follow-up research in the field of PSD rehabilitation. The results of this study can provide insightful data for subsequent studies in the field of PSD rehabilitation.
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Affiliation(s)
- Yuanyuan He
- College of Nursing, Jinan University, Guangzhou, China
| | - Xuezeng Tan
- Department of Critical Care Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Huiqi Kang
- College of Nursing, Jinan University, Guangzhou, China
| | - Huan Wang
- College of Nursing, Jinan University, Guangzhou, China
| | - Yuyao Xie
- College of Nursing, Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Vasan V, Hardigan TA, Ali M, Downes M, Devarajan A, Rossitto CP, Schuldt BR, Odland IC, Kellner CP, Fifi JT, Mocco J, Majidi S. Dysphagia after ischemic and hemorrhagic stroke: A propensity-matched 20-year analysis of the national inpatient sample. J Stroke Cerebrovasc Dis 2023; 32:107295. [PMID: 37544059 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/23/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Dysphagia is a common symptom of acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), but little is known surrounding national trends of this post-stroke condition. Hence, this study aimed to identify the risk factors for dysphagia following AIS and ICH and evaluate in-hospital outcomes in these patients. METHODS The 2000-2019 Nationwide Inpatient Sample was queried for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63) and ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 were used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of dysphagia on outcomes. RESULTS Of 10,415,286 patients with AIS, 956,662 (9.2%) had in-hospital dysphagia. Total of 2,000,868 patients with ICH were identified; 203,511 (10.2%) had in-hospital dysphagia. Patients with dysphagia after AIS were less likely to experience in-hospital mortality (OR 0.61;95%CI: 0.60-0.63) or be discharged home (AOR 0.51;95%CI: 0.51-0.52), had increased length of stay (Beta-coefficient = 0.43 days; 95%CI: 0.36-0.50), and had increased hospital charges ($14411.96;95%CI: 13565.68-15257.44) (all p < 0.001). Patients with dysphagia after ICH were less likely to experience in-hospital mortality (AOR 0.39;95%CI: 0.37-0.4), less likely to be discharged home (AOR 0.59,95%CI:0.57-0.61), have longer hospital stay (Beta-coefficient = 1.99 days;95%CI: 1.78-2.21), and increased hospital charges ($28251.93; 95%CI: $25594.57-30909.28)(all p < 0.001). CONCLUSION This is the first study to report on national trends in patients with dysphagia after AIS and ICH. These patients had longer hospital LOS, worse functional outcomes at discharge, and higher hospital costs.
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Affiliation(s)
- Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
| | - Trevor A Hardigan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Margaret Downes
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Christina P Rossitto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Braxton R Schuldt
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Ian C Odland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
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12
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Dasari PB, Verma H, Madishetty H, Pagidimarri J, Balaji J. Transadaptation and Validation of the Telugu Version of the Dysphagia Handicap Index. Semin Speech Lang 2023; 44:230-239. [PMID: 37524105 DOI: 10.1055/s-0043-1771510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Dysphagia Handicap Index (DHI) is a clinically effective, concise, and user-friendly tool for assessing the functional impact of dysphagia in clinical populations. The present study aims to trans-adapt the DHI in the Telugu language and assesses its psychometric properties. The present study was conducted in two phases. The first phase includes translating and adapting the DHI tool into Telugu (T-DHI). The second phase includes an analysis of the psychometric properties of the trans-adapted Telugu version of the DHI. The DHI was translated into the Telugu language using the forward-backward translation method. The psychometric analysis was done on 100 participants. All the participants underwent a detailed clinical swallow examination after filling the T-DHI. The overall internal consistency and Guttmann split-half reliability for the Telugu version of the DHI were good. The correlation between the T-DHI subscales and the self-perceived severity of dysphagia was found to be high. The comparison of the T-DHI scores of the control and experimental groups revealed a significant difference. The T-DHI is a reliable and valid tool to assess the quality of life of the Telugu-speaking dysphagia population.
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Affiliation(s)
| | - Himanshu Verma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harisha Madishetty
- Department of Speech Language Pathology, 1Special Place, Hyderabad, Telangana, India
| | | | - Janaki Balaji
- Department of Speech-Language Pathology, Communicate with Us, Chennai, Tamil Nadu, India
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13
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Inooka Y, Yamana H, Shinoda Y, Inokuchi H, Matsui H, Fushimi K, Yasunaga H, Haga N. Predictive Factors for Oral Intake Recovery After Acute Stroke: Analysis of a Japanese Nationwide Inpatient Database. Dysphagia 2022; 37:1623-1632. [PMID: 35218414 DOI: 10.1007/s00455-022-10423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It remains unclear which factors contribute to dysphagia recovery after an acute stroke. This study aimed to identify factors associated with complete oral intake recovery in patients with post-stroke dysphagia. METHODS Data were obtained from the Diagnosis Procedure Combination database, which is a nationwide database of administrative claims and discharge abstracts in Japan. We selected patients admitted within 3 days of stroke onset and conducted multivariable logistic regression analysis. Total oral intake within 30 days of admission was the primary outcome measure. RESULTS A total of 151,302 patients were included, and total oral intake was observed in 48% of them within 30 days of admission. Total oral intake was significantly associated with age, sex, stroke subtype, consciousness disturbance, low body mass index, multiple comorbidities, and the modified Rankin Scale before stroke onset. In addition, males had worse outcomes than females (odds ratio, 0.75; 95% confidence interval, 0.73-0.77, p < 0.001), and intracerebral and subarachnoid hemorrhagic stroke subtypes were associated with non-recovery. CONCLUSION This study identified several prognostic factors for total oral intake in patients with acute stroke. These results may be useful for predicting a patient's dysphagia prognosis at the time of admission and designing a nutritional management plan for patients with acute stroke.
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Affiliation(s)
- Yasuhiro Inooka
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Department of Rehabilitation, Yoyogi Hospital, 1-30-7 Sendagaya, Shibuya-ku, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
- Department of Rehabilitation Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, Japan.
- Department of Rehabilitation Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Iruma-Gun, Saitama, 350-0495, Japan.
| | - Haruhi Inokuchi
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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A Prospective Validation Study of the Functional Bedside Aspiration Screen with Endoscopy: Is It Clinically Applicable in Acute Stroke? J Clin Med 2022; 11:jcm11237087. [PMID: 36498662 PMCID: PMC9737958 DOI: 10.3390/jcm11237087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to investigate the reliability of the novel Functional Bedside Aspiration Screen (FBAS) to predict aspiration risk in acute stroke and to guide initial therapy needs. We conducted a prospective validation study of the FBAS 10-point scale in 101 acute ischemic stroke patients. Outcome measures were compared with the Penetration Aspiration Scale (PAS) via the Flexible Endoscopic Swallowing Study. Correlations with the Functional Oral Intake Scale (FOIS) and the Therapy Requirement Scale (TRS) were analyzed. We observed a 65.8% sensitivity and 70.2% specificity (p = 0.004) for predicting penetration risk (for PAS score ≥ 3) and a 73% sensitivity and 62% specificity for predicting aspiration risk (PAS score ≥ 6). For patients with a modified ranking scale 0-2 (n = 44) on admission, the predictive measurements of the FBAS yielded sensitivity and specificity values of 66.7% and 88.6% (p = 0.011). A significant negative correlation was found with PAS measurements, whereas a positive correlation was observed regarding FOIS. Significantly lower FBAS scores were observed in patients with high requirements for therapeutic interventions and dietary modification. FBAS may be regarded as an alternative time-efficient clinical support tool in settings in which instrumentation is not directly accessible. Further studies including a larger cohort of acute stroke patients with more severe neurological deficits are necessary.
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Cahyati Y, Ipa M, Rosdiana I. Swallowing Ability in Stroke Patients: A Case Study in Tasikmalaya Hospital, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Dysphagia is one of the problems that stroke patients often experience. Stroke patients who experience dysphagia often do not get attention because of the lack of early screening, which will cause delays in treatment. To overcome this, nurses have an essential role from the initial screening phase to independent nursing interventions. In screening for dysphagia, nurses can use various methods: Gugging Swallowing Screen (GUSS).
AIM: The purpose of the study was to identify and explain association between respondent characteristics and the GUSS method of swallowing ability scores in stroke patients.
METHODS: This research was a descriptive study, with a total sample of 20 people. The sampling technique used was consecutive sampling.
RESULTS: The results showed that based on the results of the screening test for swallowing ability using the GUSS method, it was found that most of the respondents (75%) belonged to the category of severe dysphagia. Dysphagia was associated with age (p < 0.001), gender (p = 0.000), type of stroke (p < 0.001), comorbidities (p < 0.001), and the frequency of stroke attacks (p < 0.001).
CONCLUSION: This study concludes that there is association between respondent characteristics: Age, gender, type of stroke, comorbidities, and frequency of attacks with the score of swallowing ability of stroke patients.
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